Text: HF00443 Text: HF00445 Text: HF00400 - HF00499 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 509.3, Code 2003, is amended by adding 1 2 the following new subsection: 1 3 NEW SUBSECTION. 8. a. A provision under policies, 1 4 contracts, or plans with group health benefit coverages 1 5 permitting the policyholder to renew the coverage in one-month 1 6 increments, for up to two months, at a pro rata premium rate 1 7 that is proportional to the full policy term. 1 8 b. For purposes of this subsection, "policies, contracts, 1 9 or plans with group health benefit coverages" includes all of 1 10 the following: 1 11 (1) A group policy of accident or health insurance issued 1 12 pursuant to this chapter. 1 13 (2) A group contract of a nonprofit health service 1 14 corporation issued pursuant to chapter 514. 1 15 (3) A group contract of a health maintenance organization 1 16 issued pursuant to chapter 514B. 1 17 (4) A group contract relating to care furnished by an 1 18 organized delivery system authorized under 1993 Iowa Acts, 1 19 chapter 158, licensed by the director of public health. 1 20 (5) Group health benefits provided pursuant to a multiple 1 21 employer welfare arrangement, as defined in section 3 of the 1 22 federal Employee Retirement Income Security Act of 1974, 29 1 23 U.S.C. } 1002, paragraph 40, that meets the requirements of 1 24 section 507A.4, subsection 9, paragraph "a". 1 25 (6) A plan for public employees established pursuant to 1 26 chapter 509A. 1 27 (7) An association group policy issued under section 1 28 509.14. 1 29 Sec. 2. NEW SECTION. 509.20 NOTICE OF RATE INCREASE. 1 30 1. For purposes of this section, "policy or contract for 1 31 group health benefit coverages, including a contract to 1 32 provide services to a plan providing group health benefit 1 33 coverages" applies to all of the following: 1 34 a. A group policy of health insurance under this chapter. 1 35 b. A plan established pursuant to chapter 509A for public 2 1 employees. 2 2 c. A plan offered pursuant to chapter 513B. 2 3 d. A group contract of a nonprofit health service 2 4 corporation under chapter 514. 2 5 e. A group plan of a health maintenance organization under 2 6 chapter 514B. 2 7 f. An organized delivery system authorized under 1993 Iowa 2 8 Acts, chapter 158, and licensed by the director of public 2 9 health. 2 10 g. Preferred provider contracts limiting choice of 2 11 specific provider. 2 12 h. Any other policy, contract, or plan for covering the 2 13 health care costs of a defined group. 2 14 2. A person who issues a policy or contract for group 2 15 health benefit coverages, including a contract to provide 2 16 services to a plan providing group health benefit coverages to 2 17 a group, shall provide notice of a rate increase for the 2 18 policy or contract at least forty-five days prior to the 2 19 effective date of the rate increase to the policyholder, 2 20 contract holder, or sponsor of the group health benefit plan. 2 21 Sec. 3. Section 514.6, Code 2003, is amended to read as 2 22 follows: 2 23 514.6 RATES – APPROVAL BY COMMISSIONER – NOTICE OF 2 24 INCREASE. 2 25 1. The rates charged by any such corporation to the 2 26 subscribers for health care service shall at all times be 2 27 subject to the approval of the commissioner of insurance. 2 28 2. A corporation offering health care services to 2 29 subscribers pursuant to this chapter shall provide notice of a 2 30 rate increase to subscribers at least forty-five days prior to 2 31 the effective date of the rate increase. 2 32 Sec. 4. Section 514.7, Code 2003, is amended to read as 2 33 follows: 2 34 514.7 CONTRACTS – APPROVAL BY COMMISSIONER – PROVISIONS 2 35 TO BE AVAILABLE. 3 1 1. The contracts by any such corporation with the 3 2 subscribers for health care service shall at all times be 3 3 subject to the approval of the commissioner of insurance. The 3 4 commissioner shall require that participating pharmacies be 3 5 reimbursed by the pharmaceutical service corporation at rates 3 6 or prices equal to rates or prices charged nonsubscribers, 3 7 unless the commissioner determines otherwise to prevent loss 3 8 to subscribers. 3 9 2. a. A provision shall be available in approved 3 10 contracts with hospital and medical service corporate 3 11 subscribers under group subscriber contracts or plans covering 3 12 vision care services or procedures, for payment of necessary 3 13 medical or surgical care and treatment provided by an 3 14 optometrist licensed under chapter 154, if the care and 3 15 treatment are provided within the scope of the optometrist's 3 16 license and if the subscriber contract would pay for the care 3 17 and treatment if it were provided by a person engaged in the 3 18 practice of medicine or surgery as licensed under chapter 148 3 19 or 150A. 3 20 b. The subscriber contract shall also provide that the 3 21 subscriber may reject the coverage or provision if the 3 22 coverage or provision for services which may be provided by an 3 23 optometrist is rejected for all providers of similar vision 3 24 care services as licensed under chapter 148, 150A, or 154. 3 25 c. Thisparagraphsubsection applies to group subscriber 3 26 contracts delivered after July 1, 1983, and to group 3 27 subscriber contracts on their anniversary or renewal date, or 3 28 upon the expiration of the applicable collective bargaining 3 29 contract, if any, whichever is the later. 3 30 d. Thisparagraphsubsection does not apply to contracts 3 31 designed only for issuance to subscribers eligible for 3 32 coverage under Title XVIII of the Social Security Act, or any 3 33 other similar coverage under a state or federal government 3 34 plan. 3 35 3. a. A provision shall be made available in approved 4 1 contracts with hospital and medical subscribers under group 4 2 subscriber contracts or plans covering diagnosis and treatment 4 3 of human ailments, for payment or reimbursement for necessary 4 4 diagnosis or treatment provided by a chiropractor licensed 4 5 under chapter 151 if the diagnosis or treatment is provided 4 6 within the scope of the chiropractor's license and if the 4 7 subscriber contract would pay or reimburse for the diagnosis 4 8 or treatment of the human ailments, irrespective of and 4 9 disregarding variances in terminology employed by the various 4 10 licensed professions in describing the human ailments or their 4 11 diagnosis or treatment, if it were provided by a person 4 12 licensed under chapter 148, 150, or 150A. 4 13 b. The subscriber contract shall also provide that the 4 14 subscriber may reject the coverage or provision if the 4 15 coverage or provision for diagnosis or treatment of a human 4 16 ailment by a chiropractor is rejected for all providers of 4 17 diagnosis or treatment for similar human ailments licensed 4 18 under chapter 148, 150, 150A, or 151. 4 19 c. A group subscriber contract may limit or make optional 4 20 the payment or reimbursement for lawful diagnostic or 4 21 treatment service by all licensees under chapters 148, 150, 4 22 150A, and 151 on any rational basis which is not solely 4 23 related to the license under or the practices authorized by 4 24 chapter 151 or is not dependent upon a method of 4 25 classification, categorization, or description based upon 4 26 differences in terminology used by different licensees in 4 27 describing human ailments or their diagnosis or treatment. 4 28 d. Thisparagraphsubsection applies to group subscriber 4 29 contracts delivered after July 1, 1986, and to group 4 30 subscriber contracts on their anniversary or renewal date, or 4 31 upon the expiration of the applicable collective bargaining 4 32 contract, if any, whichever is the later. 4 33 e. Thisparagraphsubsection does not apply to contracts 4 34 designed only for issuance to subscribers eligible for 4 35 coverage under Title XVIII of the Social Security Act, or any 5 1 other similar coverage under a state or federal government 5 2 plan. 5 3 4. a. A provision shall be available in approved 5 4 contracts with hospital and medical service corporate 5 5 subscribers under group subscriber contracts or plans covering 5 6 medical and surgical service, for payment of covered services 5 7 determined to be medically necessary provided by certified 5 8 registered nurses certified by a national certifying 5 9 organization, which organization shall be identified by the 5 10 Iowa board of nursing pursuant to rules adopted by the board, 5 11 if the services are within the practice of the profession of a 5 12 registered nurse as that practice is defined in section 152.1, 5 13 under terms and conditions agreed upon between the corporation 5 14 and subscriber group, subject to utilization controls. 5 15 b. Thisparagraphsubsection shall not require payment for 5 16 nursing services provided by a certified registered nurse 5 17 practicing in a hospital, nursing facility, health care 5 18 institution, a physician's office, or other noninstitutional 5 19 setting if the certified registered nurse is an employee of 5 20 the hospital, nursing facility, health care institution, 5 21 physician, or other health care facility or health care 5 22 provider. 5 23 c. Thisparagraphsubsection applies to group subscriber 5 24 contracts delivered in this state on or after July 1, 1989, 5 25 and to group subscriber contracts on their anniversary or 5 26 renewal date, or upon the expiration of the applicable 5 27 collective bargaining contract, if any, whichever is the 5 28 later. 5 29 d. Thisparagraphsubsection does not apply to limited or 5 30 specified disease or individual contracts or contracts 5 31 designed only for issuance to subscribers eligible for 5 32 coverage under Title XVIII of the federal Social Security Act, 5 33 contractswhichthat are rated on a community basis, or any 5 34 other similar coverage under a state or federal government 5 35 plan. 6 1 5. The commissioner shall require a provision permitting 6 2 the policyholder to renew the coverage in one-month 6 3 increments, for up to two months, at a pro rata premium rate 6 4 that is proportional to the full policy term. 6 5 EXPLANATION 6 6 This bill amends various Code chapters dealing with group 6 7 health insurance, to require a 45-day notice of rate increases 6 8 in premiums, and to permit a policyholder to renew the 6 9 coverage in one-month increments, for up to two months, at pro 6 10 rata rates compared to the premiums for the full policy term. 6 11 The bill adds new Code section 509.20 to require such 6 12 notice for group health insurance policies, contracts, and 6 13 plans. Code section 514.6 addresses coverage provided by a 6 14 nonprofit health service corporation. 6 15 The bill adds a new subsection to Code section 509.3 to 6 16 require a provision for policyholder renewability for up to 6 17 two months for group health insurance policies, contracts, and 6 18 plans. A new subsection in Code section 514.7 addresses the 6 19 renewability requirements with respect to coverage provided by 6 20 a nonprofit health service corporation. The bill also divides 6 21 existing Code language into subsections and paragraphs, and 6 22 makes appropriate internal language changes. 6 23 LSB 1977HH 80 6 24 jj/cf/24.1
Text: HF00443 Text: HF00445 Text: HF00400 - HF00499 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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